Giant pseudoaneurysm of the left axillary artery following a stab wound.

Axillary artery pseudoaneurysms are rare. We report on a 30-year-old patient with a 6.5-cm post-traumatic pseudoaneurysm of the left axillary artery two months after a knife stab wound of the shoulder. The patient showed axillary fullness and signs of severe brachial plexus compression. A surgical repair was undertaken. The aneurysm was excluded and a saphenous vein interposition was performed. The early and late postoperative periods were uneventful. This is probably not only the largest axillary artery pseudoaneurysm ever reported, but also the first secondary to a stab wound.

Chewing gum reduces postoperative ileus after open appendectomy.

HYPOTHESIS: It is suggested that chewing gum may accelerate postoperative intestinal transit recovery. Chewing gum may therefore produce the same result after open appendectomy. DESIGN AND SETTING: Prospective, randomized study in a University teaching hospital. PATIENTS: 46 patients operated on by open appendectomy due to acute catarrhal appendicitis, appendicular abscess and appendicular generalized peritonitis. MAIN OUTCOME MEASURES: Interest was in occurrence of first flatus, first bowel movement, hospital duration and complications. RESULTS: A total of 46 patients were randomly divided into two groups: a chewing gum group (n=23) and a control group (n=23). In the first group, patients chewed sugarless gum for 30 minutes thrice daily until resumption of intestinal transit. Patient demographics, intra-operative, and postoperative care were the same for both groups. Chewing gum was well tolerated by all the patients. The first passage of flatus occurred on postoperative day 2.2 in the gum-chewing group and on day 3.0 in the control group (P < 0.0001). The first bowel movement occurred at postoperative day 2.3 in the chewing gum group and at postoperative day 3.3 in the control group (P < 0.0001). Five complications were noted overall. Hospital stay was shorter in the chewing gum group (4.9 days.) than in the control group (6.7 days), (P < 0.0001). CONCLUSION: Chewing gum ameliorates recovery after open appendectomy by reducing postoperative ileus. It is a cheap and helpful treatment to be recommended in developing countries in Africa.

Kinetics of regression of sciatica and pain in the low back after lumbar macrodiscectomy in human immunodeficiency virus carriers.

STUDY DESIGN: Prospective longitudinal clinical study. OBJECTIVE: To evaluate the pattern of regression of severe sciatica and pain in the low back over 3 months in HIV infected patients in whom monosegmental lumbar macrodiscectomy was performed for lumbar disc herniation. SUMMARY OF BACKGROUND DATA: There are very few reported studies, which have been carried out to evaluate the outcome of lumbar discectomy in HIV positive patients. MATERIAL AND METHODS: This was a prospective study conducted from January 2004 to December 2006. Patients included were those who knew their HIV serological status before the first consultation. Patients with previous spinal surgery, multilevel lumbar disc herniation, or any neurologic deficit were excluded. The intensity of pain was assessed by the visual analog scale during regular postoperative follow up. RESULTS: Seventy-seven patients suffering from severe sciatica were included; 9 were HIV positive and 68 were HIV negative. In the HIV positive group, the sex ratio was 2:1, and 8 had severe pain in the low back whereas in the HIV negative group, 44 had severe pain in the low back. CONCLUSION: At 3 months, sciatica relief (VAS <4) was recorded in 66.6% of HIV positive patients and in 70.6% of HIV negative patients. Relief of pain in the low back (VAS <4) was respectively 50.0% and 55.1% in both groups. The pattern of pain regression during the follow-up period was similar in both groups.

[Report of the World Federation of Neurosurgical Societies (WFNS) international course and Cameroon Neurosurgery Society Congress (CNS) Yaoundé (Cameroon), 1st--4th October 2007]. / Compte rendu du cours international de la Fédération mondiale des Sociétés de Neurochirurgie et du congrés de la Société Camerounaise de Neurochirurgie Yaoundé (Cameroun), 1er--4 octobre 2007.

Neurosurgery remains a very marginal activity in sub-Saharan Africa. In this part of the world which counts nearly 40 countries, some do not have a single neurosurgeon, some have one to five, the number of ten neurosurgeons per country remaining an exception! In its concern of popularizing and of developing neurosurgery worldwide, the WFNS organized an international course in Africa, October 2007 2nd-3rd in Yaoundé (Cameroon). The Cameroon Neurosurgery Society (CNS) took this opportunity to organize its very first congress in the presence of the WFNS delegation from October 1st to 4th, 2007. The joint meeting with the WFNS was baptized the "African Week of Neurosurgery". This special event was a first in sub-Saharan Africa. The delegation of the WFNS, led by Professor J. Brotchi (Belgium) President of the WFNS, was made up of Professors A. Sousa (Brazil), Mr. Choux (France), N. Tribolet (Swiss), M. Arraez (Spain), A. Bricolo (Italy), A. Kamlichi (Morocco), G. Dechambenoit (France), K. Kalangu (Zimbabwe). Twenty three neurosurgeons coming from nine African countries (Cameroon, Nigeria, Gabon, Congo, Niger, Burkina Faso, Ivory Coast, Senegal, and Guinea) took an active part in work. The scientific success of this event led to the creation of the "Association of Neurological Surgeons of Africa (ANSA)" which will be the WFNS-Africa interface in order to insure the development of neurosurgery in Africa.

[Current clinical features of acute appendicitis in adult in Yaounde, Cameroon]. / Aspects cliniques actuels des appendicites aiguës de l'adulte à Yaoundé, Cameroun.

Our study on acute appendicitis in adults aimed to report current data in Yaounde, Cameroon. This retrospective study included 323 patients, with 185 men against 138 women (sex ratio: 1.37). Mean age was 28.3 years old. Incidence was of 4.6%. Symptoms appeared within a delay of 3 to 4 days and consisted of the triad: abdominal pain (97.5%), vomiting (44%) and anorexia (39.9%). 99.7% of the patients presented with hyperthermia whereas defence on palpation in the right iliac fossa was noted in 307 patients. Rectal examination was evocative in 92.7% of the cases. Hypemeutrophilia was found in 84.9% of the patients. Plain abdominal radiography (PAR) orientated the diagnosis in 74.3% of cases; echography was very useful in abscesses (6,5%). 96.7% of the patients underwent surgery within an average time of 48 hours. McBurney incision was performed in 232 cases. Appendice in the inner latero caecal position was predominant in 243 cases. In seven cases (2.2%), appendice was normal; 2 Meckel's diverticula were discovered (0.6%). We carried out 309 anterograde appendectomies, 317 irvaginations of the appendicular root and 14 epiplooplasties. 302 histological exams were performed; catarrhal appendicitis were ranking first: 167 cases. Morbidity reached 14.2% dominated by sepsis (71.7%). The mortality rate was 0.6%. A better diagnostic approach together with a better sensitisation of the population may shorten surgical delays inducing a decrease of morbidity of acute appendicitis in Cameroon.

Intestinal Infarctus following Dilatation and Uterine Curettage.

We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.